Gastroesophageal reflux and hiatus hernia : genesis relationship and treatment mechanisms

Abstract

The cause of both hiatus hernia and gastro-oesophageal reflux is not yet known but both are liable to spontaneous remission. The rationale for various treatment regimes is discussed. Mechanical, chemical,humoral, neurogenic and mucosal factors are involved in the protection against oesophagitis. In the present state of knowledge, there are good theoretical grounds for employing both physical measures and antacids and clinical trials have established the efficacy of alginate/antacid compounds in controlling oesophageal reflux. Where vigorous conservative measures have failed to control oesophagitis, various surgical procedures are sometimes successful but their mechanism is probably not related to the effect of obliteration of a hiatus hernia on sphincter competence.